Browsing by Author "Kaunda E"

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    A population-based cohort study of stillbirth among twins in Lusaka, Zambia.
    (2015-Jul) Stringer EM; Chibwesha C; Stoner M; Vwalika B; Joseph J; Chi BH; Kaunda E; Goodnight W; Stringer JS; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: elizabeth_stringer@med.unc.edu.; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Department of Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia.; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Clinton Health Access Initiative, Boston, MA, USA.; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    OBJECTIVE: To determine rates of stillbirth and the associated risk factors for stillbirth among twins delivered in Lusaka, Zambia. METHODS: A retrospective cohort analysis was conducted of singletons and twins delivered at 26 public sector facilities between February 1, 2006, and May 31, 2013. Data were obtained from the Zambian Electronic Perinatal Record System. Risk of stillbirth was estimated using logistic regression. RESULTS: Overall, 260 657 singletons and 4021 twin pairs were included. There were 5105 stillbirths; 317 twins were stillborn. The crude stillbirth rate for twins was 39.4 per 1000 births (95% confidence interval [CI] 35.2-43.7) whereas the rate for singletons was 18.4 per 1000 births (95% CI 17.9-18.9; P<0.001). Factors associated with stillbirth among twins were increased interval between delivery (>60 minutes), low birth weight (<2500 g), birth order (being the second-born), and difference in birth weights (>30% discordance). CONCLUSION: Twins were at an increased risk of stillbirth. Improved understanding of factors associated with stillbirth in this population could help to improve perinatal outcomes globally.
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    Predictors and pregnancy outcomes associated with a newborn birth weight of 4000 g or more in Lusaka, Zambia.
    (2013-Aug) Liu KC; Joseph JA; Nkole TB; Kaunda E; Stringer JS; Chi BH; Stringer EM; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. cherry.liu@cidrz.org; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    OBJECTIVE: To identify predictors and outcomes associated with a birth weight of 4000g or more in Lusaka, Zambia. METHODS: Data from women who delivered between February 2006 and August 2011 were obtained from electronic perinatal records at 25 public sector facilities in Lusaka. Macrosomia was defined as a birth weight of 4000g or more and normal birth weight as 2500-3999g. Maternal and newborn characteristics were analyzed for association with macrosomia. RESULTS: There were 4717 macrosomic and 187 117 normal birth weight newborns. The strongest predictors of macrosomia were high BMI (adjusted odds ratio [AOR], 2.88; 95% confidence interval [CI], 1.95-4.24), prior macrosomic newborn (AOR, 7.60; 95% CI, 6.81-8.49), and history of diabetes (AOR, 3.09; 95% CI, 1.36-6.98). Macrosomic newborns were at increased risk for cesarean delivery (AOR, 1.63; 95% CI, 1.35-1.96), fresh stillbirth (AOR, 2.24; 95% CI, 1.56-3.21), Apgar score of under 7 at 5minutes (AOR, 2.03; 95% CI, 1.33-3.11), and neonatal intensive care admission (AOR, 2.07; 95% CI, 1.32-3.23). CONCLUSION: Screening for macrosomia should be considered for high-risk patients in Sub-Saharan Africa. Institutional delivery at facilities with operating rooms and neonatal intensive care services should be encouraged.